The Pendulum Swings on Glucocorticoids in Rheumatoid Arthritis
Authors: David Fernández
Journal: Annals of Internal Medicine (2023)

EditorialsSeptember 2023The Pendulum Swings on Glucocorticoids in Rheumatoid ArthritisDavid Fernández, MD, PhDDavid Fernández, MD, PhDHospital for Special Surgery, New York, New YorkSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-1991 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Few pharmacologic agents have had as transformative an effect as glucocorticoids on the practice of medicine, with remarkable efficacy and wide applicability to numerous conditions and across specialties. Nowhere is this more evident than in rheumatology, where use of long-term low-dose steroid therapy is commonplace throughout the world, including in long-term management of diseases like polymyalgia rheumatica, systemic lupus erythematosus, and rheumatoid arthritis. However, these benefits come at a price, as the adverse effects of glucocorticoid therapy also manifest very reliably in proportion to the dose and duration of therapy, including hypertension, diabetes, loss of bone density, cushingoid features, infections, ...References1. Rice JB, White AG, Scarpati LM, et al. Long-term systemic corticosteroid exposure: a systematic literature review. Clin Ther. 2017;39:2216-2229. [PMID: 29055500] doi:10.1016/j.clinthera.2017.09.011 CrossrefMedlineGoogle Scholar2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2021;73:1108-1123. [PMID: 34101376] doi:10.1002/art.41752 CrossrefMedlineGoogle Scholar3. Strehl C, Bijlsma JWJ, de Wit M, et al. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from an EULAR task force. Ann Rheum Dis. 2016;75:952-957. [PMID: 26933146] doi:10.1136/annrheumdis-2015-208916 CrossrefMedlineGoogle Scholar4. Tieu J, Cheah JT, Black RJ, et al. Improving benefit–harm assessment of glucocorticoid therapy incorporating the patient perspective: the OMERACT glucocorticoid core domain set. Semin Arthritis Rheum. 2021;51:1139-1145. [PMID: 34253398] doi:10.1016/j.semarthrit.2021.06.010 CrossrefMedlineGoogle Scholar5. Cheah JTL, Robson JC, Black RJ, et al. The patient's perspective of the adverse effects of glucocorticoid use: a systematic review of quantitative and qualitative studies. From an OMERACT working group. Semin Arthritis Rheum. 2020;50:996-1005. [PMID: 32911291] doi:10.1016/j.semarthrit.2020.06.019 CrossrefMedlineGoogle Scholar6. Palmowski A, Nielsen SM, Boyadzhieva Z, et al. The effect of low-dose glucocorticoids over two years on weight and blood pressure in rheumatoid arthritis: individual patient data from five randomized trials. Ann Intern Med. 2023;176:1181-1189. doi:10.7326/M23-0192 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: David Fernández, MD, PhDAffiliations: Hospital for Special Surgery, New York, New YorkDisclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-1991.Corresponding Author: David Fernández, MD, PhD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021; e-mail, FernándezD@hss.edu.This article was published at Annals.org on 15 August 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis: Individual Patient Data From Five Randomized Trials Andriko Palmowski , Sabrina M. Nielsen , Zhivana Boyadzhieva , Linda Hartman , Judith Oldenkott , Björn Svensson , Ingiäld Hafström , Siegfried Wassenberg , Ernest Choy , John Kirwan , Robin Christensen , Maarten Boers , and Frank Buttgereit Metrics Current IssueSeptember 2023Volume 176, Issue 9Page: 1275-1276KeywordsBlood pressureGlucocorticoid therapyHypertensionRheumatoid arthritisRheumatologySteroid therapyWeight gain ePublished: 15 August 2023 Issue Published: September 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...